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Comment Evidence to improve the treatment of infections caused by carbapenem-resistant Gram-negative bacteria FedericoPerez, Robert ABonomo Lancet Infect Dis 2018; 8: 358-360 https://doi.org/10.1016/S1473-3099(18)30112-9 WHO recognises carbapenem-resistant Acinetobacter baumannii, Pseudomonas aeruginosa, and Entero-bacteriaceae as pathogens of crucial importance for the development of novel antibiotics.1 These bacteria manifest resistance to our most trusted therapeutic...
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Comment & Response March 6, 2018 Lung Recruitment and Positive End-Expiratory Pressure Titration in Patients With Acute Respiratory Distress Syndrome—Reply Alexandre Biasi Cavalcanti, Marcelo Britto Passos Amato, Carlos Roberto Ribeiro de Carvalho JAMA. 2018;319(9):934-935. doi:10.1001/jama.2017.21864 In Reply Dr McKown and colleagues suggest that the method used to personalize PEEP might be one explanation for the higher mortality in the recruitment maneuver and P...
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JAMA Clinical Evidence Synopsis March 6, 2018 Procalcitonin Testing to Guide Antibiotic Therapy in Acute Upper and Lower Respiratory Tract Infections Philipp Schuetz, Yannick Wirz, Beat Mueller JAMA. 2018;319(9):925-926. doi:10.1001/jama.2018.0852 Abstract Clinical Question 临床问题 Is the use of procalcitonin for guiding antibiotic decisions in patients with acute upper and lower respiratory tract infections associated with improved clinical outcomes compared with...
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Comment & Response March 6, 2018 Lung Recruitment and Positive End-Expiratory Pressure Titration in Patients With Acute Respiratory Distress Syndrome Andrew C. McKown, Matthew W. Semler, Todd W. Rice JAMA. 2018;319(9):932-933. doi:10.1001/jama.2017.21856 To the Editor The trial by the Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial (ART) Investigators1 compared a low positive end-expiratory pressure (PEEP) strategy2 with one combining a recr...
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Comment & Response February 13, 2018 Early Resuscitation for Adults With Sepsis in a Low-Income Country Wagner Luis Nedel, Caroline Deutschendorf JAMA. 2018;319(6):614. doi:10.1001/jama.2017.20406 To the Editor 致编辑 Dr Andrews and colleagues1 performed a randomized clinical trial of a sepsis protocol for early resuscitation involving intravenous fluids, vasopressors, and blood transfusion compared with usual care among adults with sepsis and hypotension in Zambi...
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Comment & Response February 13, 2018 Early Resuscitation for Adults With Sepsis in a Low-income Country—Reply Matthew W. Semler, Ben Andrews, Gordon R. Bernard JAMA. 2018;319(6):614-615. doi:10.1001/jama.2017.20410 In Reply 回复 Drs Nedel and Deutschendorf highlight 2 key considerations for the interpretation of our trial and the management of patients with sepsis across settings: (1) timing of antibiotic administration and (2) volume of intravenous fluid. Nedel和D...
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CC Nerd - The Case of the Relative Insufficiency January 20, 2018 by Rory Spiegel from https://emcrit.org/emnerd/cc-nerd-case-relative-insufficiency/ When it comes to the efficacy of glucocorticoid therapy for the treatment of septic shock, we have existed in a state of ambiguity, torn between the results of two contradictory RCTs. The first, the Annane et al trial published in JAMA in 2002, suggested a mortality benefit in favor of the corticosteroid group in the subset o...
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The End of the ‘Roid? JC: ADRENAL Dan Horner | January 22, 2018 from http://stemlynsblog.org/the-end-of-the-roid-jc-adrenal/ So another year, another Critical Care Reviews meeting . Rob is doing an absolutely fantastic job with these, inviting lead authors from major critical care trials to present and defend their work. In fact, this is going so well that this year he appears to have convinced the editor of the NEJM to coincide publication of one of the most eagerly await...
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Steroids in septic shock from http://www.thebottomline.org.uk/blog/steroids-in-sepsis/ We suggest against using IV hydrocortisone to treat septic shock patients if adequate fluid resuscitation and vasopressor therapy are able to restore hemodynamic stability. If this is not achievable, we suggest IV hydrocortisone at a dose of 200 mg per day (weak recommendation, low quality of evidence). Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Sept...
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The Definitive Word on Steroids in Septic Shock Ryan Radecki / January 19, 2018 / Resuscitation, Sepsis, Vasopressors The Definitive Word on Steroids in Septic Shock As the authors say in their introduction, glucocorticoids have been in and out of favor as adjunctive treatment of patients in septic shock for over 40 years. Various trials have found results both favoring and discounting their utility – leading, finally, to this trial to end all trials: ADRENAL. Of course, ...
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